Any Advice For Anger, PMS and Depression?

by Mona Saint MD

I have 2 children 2 years and 5 years and I feel that my PMS depression is getting worse since they were born. I suffer from very angry bouts on certain days in the middle of my periods and more recently I suffer from these during the time I have my period. It is uncontrollable anger and sadness and I just feel like crying. I can’t explain how angry I feel and I feel now that it’s affecting my life and my children. I feel very down a lot, have lost my self confidence. I went to a doctor to get a medical check and the only thing she found was under-active thyroid which can also cause depression, I am on tablets now but I don’t notice any change in my moods. A friend of mine said she had PMDD which affected her life badly and now she is on medication Prozac and it’s much better but it makes her sleepy. Please I would like some advice.

First I want to commend you for being so proactive about your health and well-being by taking the time to see your doctor and write in to us. I know this is not easy to do amidst your busy parenting schedule and the difficult symptoms you’re having. Many of the symptoms you are describing can also be present in thyroid disease, so I am glad you were evaluated for that and are on the proper medications.

I wrote a lot about PMS (premenstrual syndrome)/PMDD (premenstrual dysphoric disorder) in a prior PMS article. These disorders include many of the symptoms you describe, occur anytime up to about a week or two before your period starts, and the symptoms are usually gone by the fourth day of your period. Common symptoms include: fatigue, irritability, bloating, anxiety/tension, breast tenderness, bad mood, depression, change in appetite, acne, oversensitivity, swelling, anger, crying easily, feeling of isolation, headache, forgetfulness, gastrointestinal symptoms, poor concentration, and uncommonly hot flashes and heart palpitations. Also, I’m not sure of your age, but perimenopause can often present with irritability, mood changes, depression and agitation. Of course we cannot make a diagnosis from your question without a full evaluation in person, but you may be suffering from PMDD and/or depression from the symptoms you describe.

It can be debilitating and can make it tough to perform everyday activities, let alone taking care of the kids and work duties. I will defer to my prior PMS article for you to review an extensive list of options for treatment for this. Certainly at this point I recommend seeing a health care professional who is well versed in treating depression and PMDD. For PMDD your Ob/Gyn can care for you and write a prescription for medications. A good psychiatrist or psychologist is best for depression, but many Ob/Gyn’s and Primary Care doctors are well versed at evaluating for the common symptoms of depression and starting a prescription while you are looking for the right person to see for counseling and care.

For depression, counseling and medications are helpful, and in fact both together are needed in many cases. The newer antidepressants like Lexapro can work very well for PMDD and depression, and may be something your physician will prescribe for you after a consultation. For PMDD these can be dosed just during the PMS part of the month (the second half of the cycle), but many choose to take it daily. For depression antidepressants are dosed daily. It usually takes a few weeks to start working and is usually well tolerated but has side effects including: decreased libido, insomnia or for some people drowsiness, nausea, headaches, and hot flashes, to name a few.

The good news is that for mild depression/anxiety, PMDD, and perimenopause, you typically do not have to be on these medicines for the rest of your life. Often they can help you to get out of a rough patch, and then with lifestyle modification (exercise, better sleep and nutrition, improving your support system, reducing life stressors, eliminating stressful relationships, changing jobs, meditation or prayer, kids becoming more independent, etc.) you can eventually taper off of them. If you are pregnant or trying to conceive, it is best to avoid these medications if possible due to pregnancy related risks.

I am so sorry you are going through such a tough time, but I am proud of you for being aware of how these symptoms are problematic for you and your family and for seeking advice to help improve your life. I wish you the best of luck, and I know that with some professional guidance it will get better.

So, if hormonal imbalance (oestrogen dominance for example) is causing depression as opposed to out of synch seratonin levels, why treat them with anti-depressants? I find it extremely frustrating that so many anti-depressants are chucked down women’s throats without any real thought or exploration as to the cause of the problem. Treating symptoms might alleviate the problem in the short term but it doesn’t solve it if there is an underlying hormonal disorder.

What are your thoughts on bio-identical hormones? Should this be a consideration here? Or is the primary medical solution always going to be anti-depressants?

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Mona Saint M.D., M.P.H. is a board certified Obstetrician/Gynecologist in Orange County, CA. In addition to her extensive experience as a women’s health physician, she also completed an additional Master’s degrees in Maternal & Child Health and an Internship in Family Practice and she loves Integrative Medicine.

She is also a busy mom and lives in Orange County, CA with her three children and her husband. She loves both of her careers as a physician and mom and integrates them both into her perspectives. In her down time she loves spending time with family and close friends, loves the beach and nature, reading, meditating, cooking, wine, music, movies, design, travel, and absolutely loves ice cream, dark chocolate and her daily cup of Zen tea!